What non-pharmacological treatments can I recommend to patients with chronic sinusitis to alleviate their symptoms?

Non-pharmacological treatments for chronic sinusitis to alleviate symptoms include:

• Advise patients to avoid allergic triggers and stop smoking, including avoiding passive smoking, as these factors predispose to chronic sinusitis and can worsen symptoms.
• Encourage good control of associated disorders such as asthma and allergic rhinitis, as managing these conditions can benefit sinusitis symptoms.
• Recommend nasal saline irrigation with isotonic saline or Ringer’s lactate, which is safe and effective in adults and children for relieving nasal congestion and discharge. Avoid hypertonic saline and baby shampoo solutions due to adverse effects.
• Advise patients to avoid underwater diving due to the risk of sinus barotrauma and its serious complications.
• Promote good dental hygiene to reduce the risk of dental infections that may contribute to bacterial sinusitis.
• Consider referral to specialists if symptoms persist beyond 6–12 weeks, or if there are complicating factors such as nasal polyps, anatomical obstruction, or immunocompromise.

These recommendations are based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) and NICE/CKS guidance for chronic sinusitis management in primary care ¹.